Cardio IQ Managing Residual Risk with Advanced Cardiovascular Insights Plaque Formation Plaque Progression Plaque Rupture Outward remodeling of arterial wall Normal Accumulation of modified LDL particles Macrophages ingest modified LDLs Foam cells build fatty streaks Fibrous cap and lipid pool formation Thinning of fibrous cap, necrotic core formation Surface plaque rupture and thrombus formation Luminal obstruction from clot
The Cardio IQ Report Key Attributes Test results are shown in Optimal, Moderate, or High risk categories, and are color-coded to display progressive risk values. Age: 63 Fasting: Y Patient Information Gender: M Collected 4/2/2018 Specimen Information High Client Information Age: 63 Fasting: Y Gender: M Collected 4/2/2018 Result and Risk Category Result From High Risk Category Ranges Historic results of previous tests are provided with the Cardio IQ report to help monitor patient progress. Lipid Panel CHOLESTEROL, TOTAL mg/dl 166 <200 200-239 >=240 HDL CHOLESTEROL mg/dl 61 >=40 N/A <40 TRIGLYCERIDES mg/dl 81 <150 150-199 >=200 LDL-CHOLESTEROL mg/dl 89 <100 100-129 >129 CHOL/HDLC RATIO calc 2.7 <=3.5 3.6-5.0 >5.0 NON-HDL CHOLESTEROL mg/dl 105 <130 130-159 >159 Lipoprotein Subfractions LDL PARTICLE NUMBER nmol/l 1203 <1138 1138-1409 >1409 LDL SMALL nmol/l 236 <142 142-219 >219 LDL MEDIUM nmol/l 373 <215 215-301 >301 HDL LARGE nmol/l 9454 >6729 6729-5353 <5353 sd-ldl nmol/l 45 <=40 N/A >40 HDL2b nmol/l 35 >26 18-26 <18 Apolipoproteins APOLIPOPROTEIN A1 mg/dl 78 >=115 N/A <115 APOLIPOPROTEIN B mg/dl 80 <80 80-119 >=120 APOLIPOPROTEIN B/A1 RATIO 1.04 <0.77 0.77-0.95 >0.95 LIPOPROTEIN (a) nmol/l 77 <75 75-125 >125 Note: This report example represents the entire portfolio of Quest Diagnostics Cardio IQ tests, and is not meant to represent a specific patient. This report format is not available for patients under the age of 20 years. Reference ranges are customized by gender and age for each patient when possible, based on data from published literature. Reference range/ Comments reported separately at the end of the report. Inflammation HS CRP mg/l 4.5 <1.0 1.0-3.0 >3.0 LP PLA2 nmol/ min/ml 120 <=123 N/A >123 FIBRINOGEN ANTIGEN mg/dl 370 <350 N/A >=350 MYELOPEROXIDASE (MPO) pmol/l 550 <470 470-539 >=540 oxldl U/L 58 <60 60-69 >=70 ADMA (Asymmetric SDMA (Symmetric F2-ISOPROSTANE/ CREATININE RATIO Heart Failure ng/ml 87 <100 10-123 >123 ng/ml 138 <=135 N/A >135 ng/ml 0.82 <0.86 N/A >=0.86 PROBNP, N TERMINAL pg/ml 245 <253 N/A >=253 ST2, SOLUBLE ng/ml 30 <=35 N/A >35 GALECTIN-3 ng/ml 36 <17.9 17.9-25.9 >26.0 For further information about our Cardio IQ solution, please visit Education.QuestDiagnostics.com.
The Cardio IQ Report Key Attributes (Continued) Risk ranges indicate 3 levels of risk based on data from published literature. Result and Risk Category Result From Risk Category Ranges Metabolic Markers GLUCOSE mg/dl 110 65-99 100-125 >=126 HEMOGLOBIN A1c HOMOCYSTEINE, CARDIOVASCULAR % of total Hgb 5.8 <=5.6 5.7-6.4 >=6.5 umol/l 12.9 <11.4 N/A >=11.4 INSULIN uiu/ml 10.0 <23 N/A >=23 VITAMIN D, 25-OH, TOTAL ng/ml 86 >=30 20-29 <20 TMAO ng/ml 5.9 <6.2 6.2-9.9 >=10.0 Omega 3 & 6 Fatty Acids, Plasma OMEGA 3 (EPA+DHA) INDEX % 4.5 >3.2 2.2-3.2 <2.2 For details on reference ranges, please refer to the Reference Range/Comment section of the report. Result Comments (See Guidance Statements) Genetic Cardiovascular Markers LPA ASPIRIN GENOTYPE KIF6 GENOTYPE 9p21 GENOTYPE rs10757278 rs1333049 lle/met Trp/Arg gg cc Heterozygous carrier: associated with elevated Lp(a) levels and CVD risk and aspirin response in some clinical studies. Heterozygous carrier: associated with increased CHD risk and greater CHD event reduction with atorvastatin and pravastatin therapy in certain clinical studies. Homozygous carrier (rs10757278 and rs133049). Increased 9p21 associated CVD risk. APO E GENOTYPE 3/3 Apo E3 Carrier. Most common (normal) genotype. LPA INTRON 25 GENOTYPE tt Homozygous noncarrier. CYP2C19 GENOTYPE *2 Intermediate metabolizer. 4q25 AF RISK GENOTYPE rs2200733 rs10033464 cc gg Noncarrier: No increased 4q25 associated risk of atrial fibrillation or cardioembolic stroke. Advanced cardiovascular tests are organized into functional categories for ease of interpretation: Lipid Panel Lipoprotein Subfractionation Apolipoproteins Inflammation Heart Failure Metabolic Markers Genetic Cardiovascular Markers 4myheart Diet & Exercise Coaching Program: Need help achieving and maintaining an optimal weight? Managing stress? Trying to improve physical fitness levels? The 4myheart program provides support and personalized lifestyle guidance to help improve heart health. Please talk to your provider, visit 4myheart.com, or call 1.800.432.7889 option 2 to learn more. Medical Information for Healthcare Providers: If you have any questions about any of the tests in our Cardio IQ offering, please call 1.800.432.7889 option 3 to speak to a clinical liaison. For frequently asked questions, you can also visit us at http://education.questdiagnostics.com/faq/faq134.
The Cardio IQ Report Ion Mobility Detail Lipid subclass distributions with related results are displayed graphically for ease of patient education The y-axis of the graph shows total lipoprotein mass. The x-axis of the graph shows HDL and LDL diameter in Angstroms (Å). Shaded areas show key clinical management metrics. The height and width of the area under the curve indicate the amount of lipoprotein particles contained within each subclass. HDL (High-Density Lipids) The largest of the HDL particles is a surrogate marker for a functional cardioprotective reverse cholesterol transport mechanism. The goal of treatment for CVD risk reduction is to move from a predominance of small HDL particles to large HDL particles. LDL (Low-Density Lipids) The smaller subclasses of the LDL particles are associated with increased inflammatory potential, CVD risk, and rate of atherogenic progression. The goal of treatment for CVD risk reduction is to move from smaller to larger LDL particles. Lipid Panel Result and Risk Category Result From Risk Category Ranges CHOLESTEROL, TOTAL mg/dl 166 <200 200-239 >=240 HDL CHOLESTEROL mg/dl 61 >=40 N/A <40 TRIGLYCERIDES mg/dl 81 <150 150-199 >=200 LDL-CHOLESTEROL mg/dl 89 <100 100-129 >129 CHOL/HDLC RATIO calc 2.7 <=3.5 3.6-5.0 >5.0 NON-HDL CHOLESTEROL mg/dl 105 <130 130-159 >159 Lipoprotein Subfractions LDL PARTICLE NUMBER nmol/l 1203 <1138 1138-1409 >1409 LDL SMALL nmol/l 236 <142 142-219 >219 LDL MEDIUM nmol/l 373 <215 215-301 >301 HDL LARGE nmol/l 9454 >6729 6729-5353 <5353 sd-ldl nmol/l 45 <=40 N/A >40 HDL2b nmol/l 35 >26 18-26 <18 Apolipoproteins APOLIPOPROTEIN A1 mg/dl 78 >=115 N/A <115 APOLIPOPROTEIN B mg/dl 80 <80 80-119 >=120 APOLIPOPROTEIN B/A1 RATIO 1.04 <0.77 0.77-0.95 >0.95 LIPOPROTEIN (a) nmol/l 77 <75 75-125 >125 Inflammation HS CRP mg/l 4.5 <1.0 1.0-3.0 >3.0 LP PLA2 nmol/ 120 <=123 N/A >123 min/ml Test FIBRINOGEN Name ANTIGEN mg/dl Result From Result with Risk Category 370 Risk Category Ranges <350 N/A >=350 MYELOPEROXIDASE pmol/l Optimal Moderate High 550 Optimal <470 Moderate 470-539 >=540 High (MPO) Lipoprotein Subfractions oxldl U/L 58 <60 60-69 >=70 LDL PATTERN Pattern A A N/A B ADMA (Asymmetric ng/ml 87 <100 10-123 >123 LDL PEAK SIZE Angstrom 222.9 >222.9 222.9-217.4 <217.4 High SDMA Tertile (Symmetric cut-points are based on a reference range population. Risk of CVD events is based on a reanalysis (unpublished) of ng/ml 138 <=135 N/A >135 High F2-ISOPROSTANE/ tertile cut points are based on a reference range population. Risk of CVD events is based on ng/ml 0.82 <0.86 N/A >=0.86 a reanalysis CREATININE RATIO (unpublished) of the data presented in Musunuru et al. ATVB 2009;29:1975-1980. Heart Failure PROBNP, N TERMINAL pg/ml 245 <253 N/A >=253 ST2, SOLUBLE ng/ml 30 <=35 N/A >35 GALECTIN-3 ng/ml 36 <17.9 17.9-25.9 >26.0 For further information about our Cardio IQ solution, please visit Education.QuestDiagnostics.com.
The Cardio IQ Report Other Detail Metrics and information needed for comprehensive personalized reporting of cardiovascular risk Result and Risk Category Result From Risk Category Ranges Lipid Panel OTHER DETAIL CHOLESTEROL, TOTAL mg/dl 166 Results Results From Reference <200 Range/Comments 200-239 >=240 HDL CHOLESTEROL mg/dl 61 >=40 N/A <40 Metabolic Markers (continued) TRIGLYCERIDES mg/dl 81 <150 150-199 Lab: SLI >=200 LDL-CHOLESTEROL VITAMIN D, 25-OH, D3 mg/dl 89 10 See below ng/ml <100 100-129 >129 Reference Range: Not established CHOL/HDLC RATIO calc 2.7 <=3.5 3.6-5.0 >5.0 76 See below ng/ml VITAMIN D, 25-OH, D2 NON-HDL CHOLESTEROL mg/dl 105 Reference <130 Range: Not 130-159 established >159 Lipoprotein Subfractions Omega 3 & 6 Fatty Acids, Plasma (continued) LDL PARTICLE NUMBER nmol/l OMEGA 6/OMEGA 3 RATIO 12.0 1203 <1138 1138-1409 5.7-21.3 >1409 LDL SMALL nmol/l EPA/ARACHIDONIC ACID RATIO 0.2 236 <142 142-219 0.2 OR LESS >219 LDL ARACHIDONIC MEDIUM ACID nmol/l 8.5 373 <215 215-301 5.2-12.9% >301 HDL EPA LARGE nmol/l 9454 1.5 >6729 0.2-1.5% 6729-5353 <5353 sd-ldl DHA nmol/l 3.0 45 <=40 1.2-3.9% N/A >40 HDL2b nmol/l 35 >26 18-26 <18 Apolipoproteins Foods High in Omega-3* APOLIPOPROTEIN A1 mg/dl Fish Oils 78 Nuts and Seeds Grains >=115 and Beans N/A <115 APOLIPOPROTEIN B Salmon mg/dl Walnut 80 Walnuts Soybeans <80 80-119 >=120 APOLIPOPROTEIN B/A1 Mackerel Soybean Flax 1.04 seeds Tofu <0.77 0.77-0.95 >0.95 RATIO Sardines Flax Pecans LIPOPROTEIN (a) Swordfish nmol/l Canola 77 <75 75-125 >125 Inflammation Bluefish Cod liver HS CRP Crab mg/l Olive 4.5 <1.0 1.0-3.0 >3.0 LP PLA2 Cod nmol/ 120 Sardine <=123 N/A >123 Scallops min/ml FIBRINOGEN ANTIGEN *Adapted mg/dl from http://www.tufts.edu/med/nutrition-infection/hiv/health_omega3.html 370 <350 March 13, 2012 N/A >=350 MYELOPEROXIDASE Personal Factors (MPO) Component pmol/l Result 550 Component <470 Result 470-539 >=540 oxldl HEIGHT FEET U/L 5 ft 58 SYSTOLIC BLOOD PRESSURE <60 140 mm Hg 60-69 >=70 ADMA HEIGHT (Asymmetric INCHES ng/ml 8 in 87 DIASTOLIC BLOOD PRESSURE <100 85 mm Hg10-123 >123 WEIGHT 155 lbs TREATMENT FOR HIGH B.P. YES SDMA (Symmetric CALCULATED BMI ng/ml 23.6 DIABETES 138 <=135 NO F2-ISOPROSTANE/ AFRICAN AMERICAN NO PARENTAL HISTORY OF DIAB NO ng/ml 0.82 <0.86 CREATININE CURRENT SMOKER RATIO YES N/A N/A >135 >=0.86 Heart Failure PROBNP, N TERMINAL pg/ml 245 <253 N/A >=253 ST2, SOLUBLE ng/ml 30 <=35 N/A >35 GALECTIN-3 ng/ml 36 <17.9 17.9-25.9 >26.0 Any test component where clinical data do not support the Optimal, Moderate, or High cut points as provided on the Result with Risk Category page will be reported in the Other Detail section of the report. A diet rich in Omega-3 fatty acids is associated with a decreased risk of cardiovascular events, including sudden cardiac death (SCD). These common food items provide a ready source of Omega-3. Patient information supplied at the time of order entry used in the calculation of the Diabetes & ASCVD Risk Evaluation Scores.
The Cardio IQ Report ASCVD Risk Evaluation An expanded offering for insight into ASCVD risk is now part of the Cardio IQ Report The Lipid Panel/ASCVD Risk Panel Assessment provides the 10-year and lifetime risk and 10-year goal of atherosclerotic cardiovascular disease (ASCVD) using lipid results with anthropomorphic data and family history.* Result and Risk Category Result From Risk Category Ranges 10-Year ASCVD Risk Assessment (%) Lipid Panel CHOLESTEROL, Your Goal TOTAL mg/dl 166 <200 Your Risk: 200-239 16.4% >=240 HDL 7.5% CHOLESTEROL mg/dl Low Risk61 Intermediate Risk >=40Elevated N/A Risk <40 TRIGLYCERIDES mg/dl <=1% 81 5% <150 7.5% 150-199 >=200 >=10% LDL-CHOLESTEROL mg/dl 89 <100 100-129 >129 CHOL/HDLC RATIO calc 2.7 <=3.5 3.6-5.0 >5.0 NON-HDL CHOLESTEROL mg/dl 105 <130 130-159 >159 10-year ASCVD risk categories: > or =7.5% elevated risk; 5% to <7.5% intermediate risk; and <5% lower risk. Risk estimates Lipoprotein for an Subfractions ASCVD event (nonfatal MI, CHD death, or stroke) during the next 10 years are intended for patients currently free of clinical ASCVD; risk was estimated using the Pooled Cohort Equations: see guidelines for ethnic LDL PARTICLE NUMBER nmol/l 1203 <1138 1138-1409 >1409 group-specific considerations. [Stone et al. Circulation 2013; Goff et al. Circulation 2013] LDL SMALL nmol/l 236 <142 142-219 >219 This LDL patient-specific MEDIUM 10-year nmol/l ASCVD risk goal is based on the patient s 373 age, sex, ethnicity, <215 and optimal 215-301 levels >301 for other risk factors. This risk goal is calculated using the Pooled Cohort Equations. [Goff et al. Circulation 2013] HDL LARGE nmol/l 9454 >6729 6729-5353 <5353 sd-ldl nmol/l 45 <=40 N/A >40 HDL2b nmol/l Lifetime ASCVD Risk Assessment (%) 35 >26 18-26 <18 Lab:EZ Apolipoproteins Your Risk APOLIPOPROTEIN A1 mg/dl 78 >=115 N/A <115 NOT CALC % Not Calc: 10-year and/or lifetime risk/goal is not calculated because the required patient APOLIPOPROTEIN B mg/dl 80 <80 80-119 >=120 risk factors have not been provided (age, sex, race, systolic blood pressure, blood pressure APOLIPOPROTEIN B/A1 RATIO LIPOPROTEIN (a) medication use, diabetes, and smoker 1.04 status) or because a patient <0.77 value is 0.77-0.95 not in the range >0.95 accepted by the calculator: total cholesterol (130-320 mg/dl), HDL cholesterol (20-100 mg/ dl), systolic blood pressure (90-200 mm HG), age (20-59 years, lifetime risk; 40-79 years, nmol/l 77 <75 75-125 >125 10-year risk). Inflammation HS CRP mg/l 4.5 <1.0 1.0-3.0 >3.0 * The ASCVD risk assessment nmol/ is recommended 120 in the 2013 ACC/AHA Guidelines: Treatment <=123of Blood N/A Cholesterol >123 LP PLA2 to Reduce Atherosclerotic min/ml Cardiovascular Risk in Adults. 1 FIBRINOGEN ANTIGEN mg/dl 370 <350 N/A >=350 Risk calculations are provided at no additional cost and require the following personal factors at time of order entry: MYELOPEROXIDASE Age, Gender, Race, Systolic pmol/l BP, Diastolic BP, Treatment for 550 High Blood Pressure, <470 Diabetes, 470-539 Parental History >=540 of (MPO) Diabetes, Smoker. oxldl U/L 58 <60 60-69 >=70 ADMA (Asymmetric SDMA (Symmetric F2-ISOPROSTANE/ CREATININE RATIO ng/ml 87 <100 10-123 >123 ng/ml 138 <=135 N/A >135 ng/ml 0.82 <0.86 N/A >=0.86 Heart Failure PROBNP, N TERMINAL pg/ml 245 <253 N/A >=253 ST2, SOLUBLE ng/ml 30 <=35 N/A >35 GALECTIN-3 ng/ml 36 <17.9 17.9-25.9 >26.0 Reference 1. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013. This article is co-published in the Journal of the American College of Cardiology. For further information about our Cardio IQ solution, please visit Education.QuestDiagnostics.com.
The Cardio IQ Report Diabetic Risk Evaluation DIABETES RISK EVALUATION Glucose value and assessment Lab:EZ 110 mg/dl NORMAL PRE-DIABETES DIABETES 65 100 126 >=225 Result consistent with increased risk for diabetes The Metabolic Markers used in the Diabetes Risk Evaluation are visually presented to facilitate patient education. HbA1c value and assessment Lab:EZ 5.8% of total Hgb NORMAL PRE-DIABETES DIABETES <=4.5 5.7 6.5 >=8.0 Result consistent with increased risk for diabetes 8 Year Diabetes Risk (%) Lab:EZ 6% <=3 5 10 15 20 25 30 Risk calculations are provided at no additional cost and require the following personal factors at time of order entry: Age, Gender, Race, Systolic BP, Diastolic BP, Treatment for High Blood Pressure, Diabetes, Parental History of Diabetes, Smoker. >=35 The risk estimate is based upon the assessment of adults ages 30-79 in the Framingham study. 2 An estimate will not be provided if HbA1c and/or glucose indicate that the patient has diabetes. If fasting conditions were not met, use caution when interpreting the glucose test result and the risk estimate. Reference 2. Wilson PW, Meigs JB, Sullivan L, et al. Prediction of incident diabetes mellitus in middle-aged adults: The Framingham Offspring Study. Arch Intern Med. 2007; 167:1068-1074.
The Cardio IQ Solution Offers a comprehensive approach to heart health Assess Baseline Risk by using advanced cardiovascular testing to help characterize a patient s individual cardiovascular disease risk. Guide Personalized Therapy by using a patient s unique makeup to help determine the therapy needed to achieve better heart health. --Initiate/intensify statin therapy -- Identify opportunities for adjunct therapy -- Set diet, exercise, and lifestyle targets Monitor Response to Therapy against a patient s testing history to hone the treatment plan. Provide Ongoing Patient Support through Clinical Educators who help patients understand their test results and learn how they can adopt and adhere to their clinicians treatment plans. Offer the 4myheart Program, which is available at no additional cost for patients who have had testing performed. The Quest Diagnostics Clinical Educators work with patients to set goals, focus on lifestyle changes, and develop treatment-adherence strategies to help reduce overall cardiovascular risk. For more information, visit 4myheart.com or call 1.800.432.7889. For more information, contact your Quest Diagnostics sales representative or visit QuestDiagnostics.com/TestDirectory. QuestDiagnostics.com Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks and are the property of their respective owners. 2018 Quest Diagnostics Incorporated. All rights reserved. MD03 5/2018